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PW-4 EMPLOYEE'S WITHHOLDING CERTIFICATE FOR CITY OF PONTIAC INCOME TAX
1. Print Full Name Social Security # Office, Plant, Dept. Employee Identification #
2. Address, Number and Street City, Township or Village State Zip Code Are you a Pontiac resident?
Yes No
3. Predominant Place of employment: City under
25% 40% 60% 80% 100%
Print name of each city where you work for THIS City Total
employer and circle closest % of total earnings in under number of
each. 25% 40% 60% 80% 100% boxes
YOUR WITHHOLDING 4 Exemptions Regular $600 Additional $600 Additional
EXEMPTIONS: Check for personal exemption if 65 or $600 exemption
which yourself. exemption over by end of tax year if blind
(See instructions below.) blocks 5 Exemptions Regular $600 Additional $600 Additional
apply for your personal exemption if 65 or $600 exemption
spouse. exemption over by end of tax year if blind
Number Number
EMPLOYEE: File this form with your employer. 6. (a) Exemptions for 6. (b) Exemptions for your Enter total of
Otherwise he must withhold CITY OF PONTIAC your children other dependents. line 6(a) + 6(b)
Income Tax from your earnings without
exemptions. 7. Add the number of exemptions which you have claimed on lines 4, 5, and 6 above, and enter here.
8. Additional amount, if any, you want withheld from each paycheck. $
EMPLOYER: Keep this certificate with your.
records. If the information submitted by the I certify that the information submitted on this certificate is true, correct and complete to the best of my
employee is not believed to be true, correct knowledge and belief.
and complete, the DIRECTOR OF FINANCE
must be so advised. Date: Signature:
LINE 3 INSTRUCTIONS:
If you work for this employer in more than two cities or communities, print names of the two Michigan cities or communities where
you perform the greatest percent of your work. Circle the closest percent of total earnings for work done, or services rendered in
each city or community listed. The estimated percent of total earnings from this employer for work done or services performed
within taxing cities, is for withholding purposes only. In determining final tax liability, this estimate is subject to substantiation and
audit.
DEPENDENTS:
To qualify as your dependent, a person (a) must receive more than one-half of his or her support from you for the year, and (b)
must have less than $600 gross income during the year (except your child who is a student or who is under 19 years of age), and
(c) must not be claimed as an exemption by such person's husband or wife, and (d) must be a citizen or resident of the United
States or a resident of Canada, Mexico, the Republic of Panama or the Canal Zone (this does not apply to an alien child legally
adopted by and living with a United States citizen abroad), and (e) must (1) have your home as his principal residence and be a
member of your household for the entire year, or (2) be related to you as follows:
Your son or daughter (including legally adopted children), grandchild, stepson, stepdaughter, son-in-law, or daughter-in-law;
Your father, mother, grandparent, stepfather, stepmother, father-in-law, or mother-in-law;
Your brother, sister, stepbrother, stepsister, half brother, half sister, brother-in-law or sister-in-law;
Your uncle, aunt, nephew, or niece (but only if related by blood).
CHANGES IN EXEMPTIONS:
You should file a new certificate at any time if the number of your exemptions INCREASES. You must file a new certificate within
10 days if the number of exemptions previously claimed by you DECREASES for any of the following reasons:
Your spouse for whom you have been claiming exemption is divorced or legally separated, or claims their own exemption
on a separate certificate.
The support of a dependent for whom you claimed exemption is taken over by someone else, so that you no longer
expect to furnish more than half the support for the year.
You find that a dependent for whom you claimed exemption will receive $600 or more of income of his own during the
year (except your child who is a student or who is under 19 years of age).
Other decreases in exemptions, such as the death of a wife or a dependent, do not affect your withholding until the next year, but
require the filing of a new certificate by December 1 of the year in which they occur.
CHANGE OF RESIDENCE:
You must file a new certificate within 10 days after you change your residence from or to a taxing city.
CHANGES IN EMPLOYMENT:
You must file a new certificate by December 1 of each year if your line 3 estimate of the percent of work done for services to be
rendered in cities levying an income tax will change for the next year.
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